Évolution de la gestion pharmacologique de la polyarthrite rhumatoïde et impact sur le risque de fracture ostéoporotique non vertébrale

Au cours des dernières années, le développement des connaissances au niveau de l’étiologie de la maladie ainsi que l’arrivée de nouveaux médicaments et de lignes directrices guidant la pratique clinique sont susceptibles d’avoir entraîné une meilleure gestion de la polyarthrite rhumatoïde (PAR) et de l’ostéoporose, une comorbidité fréquente chez ces patients. Dans cette thèse, trois questions de recherche sont étudiées à l’aide des banques de données administratives québécoises (RAMQ, MED-ÉCHO). Une première étude documente l’utilisation des médicaments pour la PAR au Québec. À ce jour, il s’agit de la seule étude canadienne à rapporter les tendances d’utilisation des DMARD (disease-modifying antirheumatic drug) biologiques depuis leur introduction dans la pratique clinique. Au cours de la période à l’étude (2002-2008), l’utilisation de DMARD (synthétiques et biologiques) a augmenté légèrement dans la population atteinte de PAR (1,9%, 95% CI : 1,1 - 2,8). Cependant, malgré la présence de recommandations cliniques soulignant l’importance de commencer un traitement rapidement, et la couverture de ces traitements par le régime général d’assurance médicaments, les résultats démontrent une initiation sous-optimale des DMARD chez les patients nouvellement diagnostiqués (probabilité d’initiation à 12 mois : 38,5%). L’initiation de DMARD était beaucoup plus fréquente lorsqu’un rhumatologue était impliqué dans la provision des soins (OR : 4,31, 95% CI : 3,73 - 4,97). Concernant les DMARD biologiques, le facteur le plus fortement associé avec leur initiation était l’année calendrier. Chez les sujets diagnostiqués en 2002, 1,2 sur 1 000 ont initié un DMARD biologique moins d’un an après leur diagnostic. Pour ceux qui ont été diagnostiqués en 2007, le taux était de 13 sur 1 000. Les résultats démontrent que si la gestion pharmacologique de la PAR s’est améliorée au cours de la période à l’étude, elle demeure tout de même sous-optimale. Assurer un meilleur accès aux rhumatologues pourrait, semble-t-il, être une stratégie efficace pour améliorer la qualité des soins chez les patients atteints de PAR. Dans une deuxième étude, l’association entre l’utilisation des DMARD biologiques et le risque de fractures ostéoporotiques non vertébrales chez des patients PAR âgés de 50 ans et plus a été rapportée. Puisque l’inflammation chronique résultant de la PAR interfère avec le remodelage osseux et que les DMARD biologiques, en plus de leur effet anti-inflammatoire et immunosuppresseur, sont des modulateurs de l’activité cellulaire des ostéoclastes et des ostéoblastes pouvant possiblement mener à la prévention des pertes de densité minérale osseuse (DMO), il était attendu que leur utilisation réduirait le risque de fracture. Une étude de cas-témoin intra-cohorte a été conduite. Bien qu’aucune réduction du risque de fracture suivant l’utilisation de DMARD biologiques n’ait pu être démontrée (OR : 1,03, 95% CI : 0,42 - 2,53), l’étude établit le taux d’incidence de fractures ostéoporotiques non vertébrales dans une population canadienne atteinte de PAR (11/1 000 personnes - années) et souligne le rôle d’importants facteurs de risque. La prévalence élevée de l’ostéoporose dans la population atteinte de PAR justifie que l’on accorde plus d’attention à la prévention des fractures. Finalement, une troisième étude explore l’impact de la dissémination massive, en 2002, des lignes directrices du traitement de l’ostéoporose au Canada sur la gestion pharmacologique de l’ostéoporose et sur les taux d’incidence de fractures ostéoporotiques non vertébrales chez une population de patients PAR âgés de 50 ans et plus entre 1998 et 2008. Étant donné la disponibilité des traitements efficaces pour l’ostéoporose depuis le milieu des années 1990 et l’évolution des lignes directrices de traitement, une réduction du taux de fractures était attendue. Quelques études canadiennes ont démontré une réduction des fractures suivant une utilisation étendue des médicaments contre l’ostéoporose et de l’ostéodensitométrie dans une population générale, mais aucune ne s’est attardée plus particulièrement sur une population adulte atteinte de PAR. Dans cette étude observationnelle utilisant une approche de série chronologique, aucune réduction du taux de fracture après 2002 (période suivant la dissémination des lignes directrices) n’a pu être démontrée. Cependant, l’utilisation des médicaments pour l’ostéoporose, le passage d’ostéodensitométrie, ainsi que la provision de soins pour l’ostéoporose en post-fracture ont augmenté. Cette étude démontre que malgré des années de disponibilité de traitements efficaces et d’investissement dans le développement et la promotion de lignes directrices de traitement, l’effet bénéfique au niveau de la réduction des fractures ne s’est toujours pas concrétisé dans la population atteinte de PAR, au cours de la période à l’étude. Ces travaux sont les premiers à examiner, à l’aide d’une banque de données administratives, des sujets atteints de PAR sur une période s’étalant sur 11 ans, permettant non seulement l’étude des changements de pratique clinique suivant l’apparition de nouveaux traitements ou bien de nouvelles lignes directrices, mais également de leur impact sur la santé. De plus, via l’étude des déterminants de traitement, les résultats offrent des pistes de solution afin de combler l’écart entre la pratique observée et les recommandations cliniques. Enfin, les résultats de ces études bonifient la littérature concernant la qualité des soins pharmacologiques chez les patients PAR et de la prévention des fractures.

Activism and participation among people of migrant background : discourses and practices of inclusiveness in four italian cities

Alors que l’intérêt pour les processus d’intégration des immigrants et des minorités ethniques est en pleine croissance parmi les chercheurs européens, les facteurs qui expliquent les différentes formes de participation civique et politique doivent être examinés plus en profondeur. Prenant pour base la littérature sur l’immigration, cette étude examine la question de recherche suivante: Comment peut-on expliquer les variations des formes de participation civique et politique des activistes issus de l’immigration au niveau local? Afin de répondre à cette question, cette étude identifie les formes de participation de la part d’activistes issus de l’immigration dans quatre villes Italiennes et examine les discours et les pratiques de multiples acteurs impliqués dans le domaine de l’immigration dans un contexte national d’hostilité croissante. Cette thèse soutient que pour comprendre différentes formes de participation, il est important de considérer non seulement l’État et les acteurs institutionnels, mais aussi les acteurs non-institutionnels et examiner comment ces derniers influencent les opportunités ainsi que les restrictions à la participation. Par ailleurs, cette recherche examine les canaux conventionnels et non-conventionnels dans quatre villes italiennes et étudie les activistes issus de l’immigration comme des acteurs politiques pertinents, capables de se mobiliser et d’influencer la participation à travers leur interaction et alliances avec les acteurs de la société d’accueil. Cette recherche a permis de produire trois résultats. Le premier montre que les approches d’intégration adoptées par les acteurs sont importantes. Cette étude a identifié trois approches d’intégration: 1) « welfariste », basée sur l’idée que les immigrants sont dans le besoin et doivent donc recevoir des services; 2) interculturelle, basée sur l’idée que les immigrants sont de futurs citoyens et que l’intégration est réciproque; 3) promotion des droits politiques, basée sur l’idée que les immigrants ont des droits politiques fondamentaux ; et qui encourage l’ouverture des canaux de participation politique, surtout aux immigrants privés du droit de vote local. L’analyse empirique démontre que, alors que l’approche welfariste n’encourage pas la participation parce qu’elle conçoit les immigrants comme des acteurs passifs, les autres deux approches ont respectivement un impact sur les formes de participation civique et politique. La deuxième conclusion souligne le rôle des acteurs de gauche. En particulier, cette étude montre que les acteurs qui ouvrent de canaux pour la participation ne sont pas uniquement les acteurs de gauche modérée, comme les autorités locales, les partis politiques et les syndicats, mais aussi les groupes de gauche radicale et non-institutionnelle. Chaque acteur de gauche comprend et agit différemment par rapport aux sujets de l’immigration et de la participation et ce fait influence comment les activistes issues de l’immigration se mobilisent. La troisième conclusion met en évidence le rôle de la perception des opportunités par les activistes issus de l’immigration et la façon avec laquelle ils s’approprient les discours et les pratiques des acteurs de gauche. Ce travail démontre que l’ouverture de canaux est possible grâce à l’engagement de personnes issues de l’immigration qui agissent à travers les opportunités qui leurs sont offertes, créent des alliances avec la gauche et défient les discours et pratiques des acteurs locaux.

Legal Protection for Consumer of Pharmaceutical Products

The overall focus of the thesis involves the legal protection for consumers of pharmaceutical products.The work on “Legal Protection for Consumers of Pharmaceutical Products” is undertaken to study the legal framework that is existing for this purpose and the functioning of regulating mechanism that is envisaged under it. The purpose of the study is to analyse how far these measures are effective in adequately protecting various aspects of consumer interest. Methodology adopted for the study is analytical.The present study revealed that the theory of freedom of contract is only an ideal relevant when the parties are assumed to be on equal footing.In a more complicated social and economic society, it ceased to have any relevance. Many countries in the world enacted legislations to protect the consumers of pharmaceutical products.The meaning of ‘consumers of drugs’ provided in the law is inclusive and not exhaustive one. The definition of ‘drug’ as interpreted by the courts is comprehensive enough to take in it not only medicines but also substances. The meaning of the word substances has been widened by the interpretation of the courts so as to include all the things used in treatment.The definition of the word ‘consumer’ has been liberally interpreted by the courts so as to provide protective net to a large section of the public.The studies subsequent to this report also revealed that there is a shortage of essential drugs necessary to cure local diseases like tuberculosis and malaria where as drugs containing vitamins and other combinations which are more profitable for the manufacturers are produced and marketed in abundance.The study of the provisions in this regard revealed that the duty of the drug controlling authorities is confined to scrutinize the data of the clinical test already conducted by the sponsor of the drug.Study of the clinical trial procedure under the U.S. law revealed that there is a continuous supervision over clinical trials and controls are provided on the treatment use of an investigational productStudy of the clinical trial procedure under the U.S. law revealed that there is a continuous supervision over clinical trials and controls are provided on the treatment use of an investigational product.the study of the provisions of the Drugs and Cosmetics Act and the rules framed under it revealed that the law in this regard is comprehensive to protect the consumer provided it is sufficiently supported by adequately equipped enforcement machinery.

Studies on fish waste management practices in Aroor Seafood Industrial Belt, Kerala and conversion of seafood waste into a liquid plant growth supplement

This study was materialized to analyze the management issues regarding the seafood processing waste generated including its impact on the coastal community in one of the important seafood hubs of India Aroor Seafood Industrial Belt Alappuzha District Kerala The area has witnessed serious pollution issues related to seafood waste and seldom has any action been implemented by either the polluters or the preventers Further this study is also intended to suggest a low cost eco friendly method for utilizing the bulk quantity of seafood solid waste generated in the area for the promotion of organic farming The high nutritional value of seafood enables the subsequent offal to be considered as an excellent source for plant nutrition The liquid silage accepted worldwide as the cheapest and practical solution for rendering fish waste in bulk for production of livestock feed is adopted in this study to develop foliar fertilizer formulations from various seafood waste The effect of seafood foliar sprays is demonstrated by field studies on two plant varieties such as Okra and Amaranthus

Can commercialization of NTFPs alleviate poverty? A case study of Ricinodendron heudelotii (Baill.) Pierre ex Pax. kernel marketing in Cameroon

Ricinodendron heudelotii (Baill.) Pierre ex Pax. kernel (njansang) commercialization has been promoted by the World Agroforestry Centre (ICRAF) in project villages in Cameroon with the aim to alleviate poverty for small-scale farmers. We evaluated to what extent development interventions improved the financial situation of households by comparing project and control households. The financial importance of njansang to household livelihoods between 2005 and 2010 was investigated through semi-structured questionnaires with retrospective questions, focus group discussions, interviews and wealth-ranking exercises. The importance of njansang increased strongly in the entire study region and the increase was significantly larger in project households. Moreover, absolute numbers of income from njansang commercialization as well as relative importance of njansang in total cash income, increased significantly more in project households (p < 0.05). Although the lower wealth class households could increase their income through njansang trade, the upper wealth class households benefited more from the projects' interventions. Group sales as conducted in project villages did not lead to significantly higher prices and should be reconsidered. Hence, promotion of njansang had a positive effect on total cash income and can still be improved. The corporative actors for njansang commercialization are encouraged to adapt their strategies to ensure that also the lower wealth class households benefit from the conducted project interventions. In this respect, frequent project monitoring and impact analysis are important tools to accomplish this adaptation.

Development and Integration of Biocontrol Products in Branched Broomrape (Phelipanche ramosa) management in Tomato

Parasitic weeds of the genera Striga, Orobanche, and Phelipanche pose a severe problem for agriculture because they are difficult to control and are highly destructive to several crops. The present work was carried out during the period October, 2009 to February, 2012 to evaluate the potential of arbuscular mycorrhizal fungi (AMF) to suppress P. ramosa on tomatoes and to investigate the effects of air-dried powder and aqueous extracts from Euphorbia hirta on germination and haustorium initiation in Phelipanche ramosa. The work was divided into three parts: a survey of the indigenous mycorrhizal flora in Sudan, second, laboratory and greenhouse experiments (conducted in Germany and Sudan) to construct a base for the third part, which was a field trial in Sudan. A survey was performed in 2009 in the White Nile state, Sudan to assess AMF spore densities and root colonization in nine fields planted with 13 different important agricultural crops. In addition, an attempt was made to study the relationship between soil physico-chemical properties and AMF spore density, colonization rate, species richness and other diversity indices. The mean percentage of AMF colonization was 34%, ranging from 19-50%. The spore densities (expressed as per 100 g dry soil) retrieved from the rhizosphere of different crops were relatively high, varying from 344 to 1222 with a mean of 798. There was no correlation between spore densities in soil and root colonization percentage. A total of 45 morphologically classifiable species representing ten genera of AMF were detected with no correlation between the number of species found in a soil sample and the spore density. The most abundant genus was Glomus (20 species). The AMF diversity expressed by the Shannon–Weaver index was highest in sorghum (H\= 2.27) and Jews mallow (H\= 2.13) and lowest in alfalfa (H\= 1.4). With respect to crop species, the genera Glomus and Entrophospora were encountered in almost all crops, except for Entrophospora in alfalfa. Kuklospora was found only in sugarcane and sorghum. The genus Ambispora was recovered only in mint and okra, while mint and onion were the only species on which no Acaulospora was found. The hierarchical cluster analysis based on the similarity among AMF communities with respect to crop species overall showed that species compositions were relatively similar with the highest dissimilarity of about 25% separating three of the mango samples and the four sorghum samples from all other samples. Laboratory experiments studied the influence of root and stem exudates of three tomato varieties infected by three different Glomus species on germination of P. ramosa. Root exudates were collected 21or 42 days after transplanting (DAT) and stem exudates 42 DAT and tested for their effects on germination of P. ramosa seeds in vitro. The tomato varieties studied did not have an effect on either mycorrhizal colonization or Phelipanche germination. Germination in response to exudates from 42 day old mycorrhizal plants was significantly reduced in comparison to non-mycorrhizal controls. Germination of P. ramosa in response to root exudates from 21 day old plants was consistently higher than for 42 day-old plants (F=121.6; P<.0001). Stem diffusates from non-mycorrhizal plants invariably elicited higher germination than diffusates from the corresponding mycorrhizal ones and differences were mostly statistically significant. A series of laboratory experiments was undertaken to investigate the effects of aqueous extracts from Euphorbia hirta on germination, radicle elongation, and haustorium initiation in P. ramosa. P. ramosa seeds conditioned in water and subsequently treated with diluted E. hirta extract (10-25% v/v) displayed considerable germination (47-62%). Increasing extract concentration to 50% or more reduced germination in response to the synthetic germination stimulants GR24 and Nijmegen-1 in a concentration dependent manner. P. ramosa germlings treated with diluted Euphorbia extract (10-75 % v/v) displayed haustorium initiation comparable to 2, 5-Dimethoxy-p-benzoquinon (DMBQ) at 20 µM. Euphorbia extract applied during conditioning reduced haustorium initiation in a concentration dependent manner. E. hirta extract or air-dried powder, applied to soil, induced considerable P. ramosa germination. Pot experiments were undertaken in a glasshouse at the University of Kassel, Germany, to investigate the effects of P. ramosa seed bank on tomato growth parameters. Different Phelipanche seed banks were established by mixing the parasite seeds (0 - 32 mg) with the potting medium in each pot. P. ramosa reduced all tomato growth parameters measured and the reduction progressively increased with seed bank. Root and total dry matter accumulation per tomato plant were most affected. P. ramosa emergence, number of tubercles, and tubercle dry weight increased with the seed bank and were, invariably, maximal with the highest seed bank. Another objective was to determine if different AM fungi differ in their effects on the colonization of tomatoes with P. ramosa and the performance of P. ramosa after colonization. Three AMF species viz. GIomus intraradices, Glomus mosseae and Glomus Sprint® were used in this study. For the infection, P. ramosa seeds (8 mg) were mixed with the top 5 cm soil in each pot. No mycorrhizal colonization was detected in un-inoculated control plants. P. ramosa infested, mycorrhiza inoculated tomato plants had significantly lower AMF colonization compared to plants not infested with P. ramosa. Inoculation with G. intraradices, G. mosseae and Glomus Sprint® reduced the number of emerged P. ramosa plants by 29.3, 45.3 and 62.7% and the number of tubercles by 22.2, 42 and 56.8%, respectively. Mycorrhizal root colonization was positively correlated with number of branches and total dry matter of tomatoes. Field experiments on tomato undertaken in 2010/12 were only partially successful because of insect infestations which resulted in the complete destruction of the second run of the experiment. The effects of the inoculation with AMF, the addition of 10 t ha-1 filter mud (FM), an organic residues from sugar processing and 36 or 72 kg N ha-1 on the infestation of tomatoes with P. ramosa were assessed. In un-inoculated control plants, AMF colonization ranged between 13.4 to 22.1% with no significant differences among FM and N treatments. Adding AMF or FM resulted in a significant increase of branching in the tomato plants with no additive effects. Dry weights were slightly increased through FM application when no N was applied and significantly at 36 kg N ha-1. There was no effect of FM on the time until the first Phelipanche emerged while AMF and N application interacted. Especially AMF inoculation resulted in a tendency to delayed P. ramosa emergence. The marketable yield was extremely low due to the strong fruit infestation with insects mainly whitefly Bemisia tabaci and tomato leaf miner (Tuta absoluta). Tomatoes inoculated with varied mycorrhiza species displayed different response to the insect infestation, as G. intraradices significantly reduced the infestation, while G. mosseae elicited higher insect infestation. The results of the present thesis indicate that there may be a potential of developing management strategies for P. ramosa targeting the pre-attachment stage namely germination and haustorial initiation using plant extracts. However, ways of practical use need to be developed. If such treatments can be combined with AMF inoculation also needs to be investigated. Overall, it will require a systematic approach to develop management tools that are easily applicable and affordable to Sudanese farmers. It is well-known that proper agronomical practices such as the design of an optimum crop rotation in cropping systems, reduced tillage, promotion of cover crops, the introduction of multi-microbial inoculants, and maintenance of proper phosphorus levels are advantageous if the mycorrhiza protection method is exploited against Phelipanche ramosa infestation. Without the knowledge about the biology of the parasitic weeds by the farmers and basic preventive measures such as hygiene and seed quality control no control strategy will be successful, however.

Diversity, local uses and availability of medicinal plants and wild yams in the Mahafaly region of south-western Madagascar

Short summary: This study was undertaken to assess the diversity of plant resources utilized by the local population in south-western Madagascar, the social, ecological and biophysical conditions that drive their uses and availability, and possible alternative strategies for their sustainable use in the region. The study region, ‘Mahafaly region’, located in south-western Madagascar, is one of the country’s most economically, educationally and climatically disadvantaged regions. With an arid steppe climate, the agricultural production is limited by low water availability and a low level of soil nutrients and soil organic carbon. The region comprises the recently extended Tsimanampetsotsa National Park, with numerous sacred and communities forests, which are threatened by slash and burn agriculture and overexploitation of forests resources. The present study analyzed the availability of wild yams and medicinal plants, and their importance for the livelihood of the local population in this region. An ethnobotanical survey was conducted recording the diversity, local knowledge and use of wild yams and medicinal plants utilized by the local communities in five villages in the Mahafaly region. 250 households were randomly selected followed by semi-structured interviews on the socio-economic characteristics of the households. Data allowed us to characterize sociocultural and socioeconomic factors that determine the local use of wild yams and medicinal plants, and to identify their role in the livelihoods of local people. Species-environment relationships and the current spatial distribution of the wild yams were investigated and predicted using ordination methods and a niche based habitat modelling approach. Species response curves along edaphic gradients allowed us to understand the species requirements on habitat conditions. We thus investigated various alternative methods to enhance the wild yam regeneration for their local conservation and their sustainable use in the Mahafaly region. Altogether, six species of wild yams and a total of 214 medicinal plants species from 68 families and 163 genera were identified in the study region. Results of the cluster and discriminant analysis indicated a clear pattern on resource, resulted in two groups of household and characterized by differences in livestock numbers, off-farm activities, agricultural land and harvests. A generalized linear model highlighted that economic factors significantly affect the collection intensity of wild yams, while the use of medicinal plants depends to a higher degree on socio-cultural factors. The gradient analysis on the distribution of the wild yam species revealed a clear pattern for species habitats. Species models based on NPMR (Nonparametric Multiplicative Regression analysis) indicated the importance of vegetation structure, human interventions, and soil characteristics to determine wild yam species distribution. The prediction of the current availability of wild yam resources showed that abundant wild yam resources are scarce and face high harvest intensity. Experiments on yams cultivation revealed that germination of seeds was enhanced by using pre-germination treatments before planting, vegetative regeneration performed better with the upper part of the tubers (corms) rather than the sets of tubers. In-situ regeneration was possible for the upper parts of the wild tubers but the success depended significantly on the type of soil. The use of manure (10-20 t ha¹) increased the yield of the D. alata and D. alatipes by 40%. We thus suggest the promotion of other cultivated varieties of D. alata found regions neighbouring as the Mahafaly Plateau.

Fabrication of Controlled Release Devices Using Supercritical Antisolvent Method

In this study, the supercritical antisolvent with enhanced mass transfer method (SASEM) is used to fabricate micro and nanoparticles of biocompatible and biodegradable polymer PLGA (poly DL lactide co glycolic acid). This process may be extended to the encapsulation of drugs in these micro and nanoparticles for controlled release purposes. Conventional supercritical antisolvent (SAS) process involves spraying a solution (organic solvent + dissolved polymer) into supercritical fluid (CO[subscript 2]), which acts as an antisolvent. The high rate of mass transfer between organic solvent and supercritical CO[subscript 2] results in supersaturation of the polymer in the spray droplet and precipitation of the polymer as micro or nanoparticles occurs. In the SASEM method, ultrasonic vibration is used to atomize the solution entering the high pressure with supercritical CO[subscript 2]. At the same time, the ultrasonic vibration generated turbulence in the high pressure vessel, leading to better mass transfer between the organic solvent and the supercritical CO₂. In this study, two organic solvents, acetone and dichloromethane (DCM) were used in the SASEM process. Phase Doppler Particle Analyzer (PDPA) was used to study the ultrasonic atomization of liquid using the ultrasonic probe for the SASEM process. Scanning Electron Microscopy (SEM) was used to study the size and morphology of the polymer particles collected at the end of the process.

Databases and cooperative projects of the IZI documentation centre : promoting media literacy. 'Bases de datos y proyectos cooperativos del centro de documentación IZI : promoviendo la alfabetización de los medios de comunicación'.

El Instituto Internacional Central para la Televisión Juvenil y Educativa (IZI) es un centro de investigación y documentación dedicado a promover la calidad en la televisión y medios de comunicación para niños y jóvenes y educación. El departamento de documentación del IZI cuenta con una base de datos de referencia internacional para educadores, investigadores, padres, estudiantes y especialistas de la información. Además el IZI participa en redes nacionales e internacionales educativas documentales. El objetivo esencial de estos proyectos cooperativos es la promoción de la alfabetización de medios de comunicación, que constituye una habilidad imprescindible en la sociedad del conocimiento.

Fundamental Right to Freedom of Conscience without Objection? Some Notes for its Recognition as a Fundamental Guarantee

Conscientious objection is defined as the ability to depart from statutory mandates because of intimate convictions based on ethical or religious convictions. A discussion of this issue presents the conflict between the idea of a State concerned with the promotion of individual rights or the protection of general interests and an idea of law based on the maintenance of order and against a view of the law as a means to claim the protection of minimum conditions of the person. From this conflict is drawn the possibility to argue whether conscientious objection should be guaranteed as a fundamental right of freedom of conscience or as a statutory authority legislatively conferred upon persons. This paper sets out a discussion around the two views so as to develop a position that is more consistent with the context of social and constitutional law.

Description of the risk factors for relapse in patients diagnosed with severe mental disorders

Objective: The objective of this paper is to describe the population served in mental health institutionsfor mental illness relapse, and the process of identifying risk factors in relapsing patientsdiagnosed with severe mental illness. To this end a descriptive exploratory multicenter, multistageepidemiological study was carried out in mental health institutions of the Order of San Juan deDios Hospital (OHSJD) with hospitalized relapsing patients with a diagnosis of severe mentaldisorder. This study comes from a working network of Psychology professionals in the OHSJDnationwide. Materials and methods: The population sample was of 1005 patients diagnosed withsevere mental disorders, who had presented relapse during the last year. First, the characterizationof the general population was conducted; then, it was narrowed down to the centers, taking intoaccount similarities and differences found according to the clinical and demographic variables.Results: Major risk factors for relapse found in patients diagnosed with severe mental disorderswere: having between 38 and 58 years of age, being female, single, graduates, unemployed, witha prevalence of bipolar affective disorder diagnosis, number of hospitalizations between 2 and10, number of drugs at the time of leaving hospital 2 to 6, with severe difficulties relating withothers and difficulties in adherence to treatment. The need for a caregiver was also found, as wellas a limited number of received psychological interventions. How the system of beliefs affects thedisease and the poor adherence to treatment was identified. Conclusions: These results indicatethe requirement of a design of team intervention strategies, ranging from the assessment team(home), definition of therapeutic action plans (for) and the posthospitalizacion (egress) following.There is a poor support network and limited adherence to comprehensive treatment.

Estratégias da promoção da saúde em escolares do grupo etário 15-19 anos

Este trabalho teve por base a promoção da saúde em escolares dos 15 aos 19 anos e estudar as possíveis estratégias a aplicar para se atingir este fim. Dentro deste tema analisaram-se os níveis de alcoolismo, tabagismo e drogas tanto a nível nacional como internacional com o fim de perceber a dimensão destes riscos assim como elaborar possíveis programas para diminuir os consumos destas substâncias. Os principais problemas na adolescência são as dependências tais como o alcoolismo, tabagismo e drogas que levam muitas vezes também a acidentes rodoviários. Existem também muitos problemas de saúde associados à imagem física tais como a obesidade, a anorexia e a acne. Além destes problemas, há também alguma falta de educação sexual de maneira a prevenir as doenças sexualmente transmissíveis e as gravidezes indesejáveis, assim como, mais recentemente, o bulling e cyberbulling. Dentro destes possíveis problemas que podem ocorrer na adolescência, aprofundou-se neste trabalho as dependências do álcool, tabaco e drogas por parte dos adolescentes dos 15 aos 19 anos. Dentro deste tema analisaram-se as razões do aparecimento destes problemas nos adolescentes, porque começam o consumo destas substâncias, quais as suas motivações e quais as estratégias a adotar para prevenir este tipo de consumos e posteriores consequências físicas e mentais no futuro.

Socio-cultural visions of interactivity within Museums

The ideas on which this paper is based are drawn from my thesis “Interactivity in Museums. A Relationship Building Perspective” written in 2007 for the fulfillment of the Master Degree in Museology at the Reinwardt Academy in Amsterdam. The main arguments are that the notion of Interactivity conceptualized within a technological orientation coupled with the pedagogic approach of mere information transmission need to be reconsidered; that Interactivity in museums is a conception both misinterpreted and under-implemented; and that the problems of understanding Interactivity will resolve by identifying the aspects which define Interactivity and most importantly focus on why they matter in a broader socio-cultural context within museums. Without an intention to attribute all the developments and advances associated with new museological practice, in some deterministic way, solely to politics and economic change, I argue that the new strategies adopted by museums towards progression and broader accessibility –at least regarding interactivity, seem to be linked more with a dominant commercialization of culture and education, than with a belief towards an effect on social change through the promotion of social interaction within a pluralistic and multicultural society, acknowledging the diversity of nature, opinion and practices, which can be combined instead of contrasting each other.

The School of Museology Celje: regular, continuous, topical, quality form of education

At the School of Museology, a project with ten years of tradition, we carry out module-based programmes to educate and qualify different target audiences working in the filed of cultural heritage. Our development and realization of educational programmes and training courses directed at practical applicability, including life-long learning of adults, topic complementarity with related professional and scientific fields, connection with universities offering undergraduate and postgraduate studies of heritages, promotion of theoretical museological discourses raising awareness of the meaning of cultural heritage, firm placement in an international network of related institutions and promotion of international relations with special emphasis on neighbouring countries. We encourage project partnership and cooperate with different domestic and foreign associates in forming and carrying out programmes.

Autocuidados e automedicação na temática da obstipação

Atualmente, consideram-se os autocuidados como a primeira forma de prevenção e tratamento de doenças. Através de alterações no estilo de vida e da automedicação é possível obter enormes benefícios, não só na saúde mas também na economia do próprio país. Para que estas medidas sejam eficazes e seguras, é essencial garantir a formação e informação da sociedade, sendo os profissionais de saúde os principais intervenientes neste processo. Assim, o farmacêutico deve intervir junto da população, não só na promoção da saúde, como também no incentivo ao uso racional dos medicamentos. São diversas as situações passíveis de automedicação e são igualmente vários os casos de utilização incorreta de medicamentos neste contexto. Assim, optou-se por destacar a automedicação na obstipação com recurso não só a Medidas Não Farmacológicas, como também à utilização de laxantes. A obstipação é um conjunto de sintomas associado a determinada causa. Fatores desencadeantes podem ser de origem patológica ou de origem comportamental, destacando-se o stress, polimedicação e hábitos de consumo. Os laxantes são normalmente utilizados no tratamento da obstipação, no entanto, temse conhecimento que podem ser indevidamente usados para outros fins, nomeadamente em contexto de distúrbios alimentares. A dependência destes medicamentos é elevada quando utilizados de forma incorreta, por tempo prolongado e em elevada frequência. Deste modo, o presente estudo tem como principais objetivos percecionar quais as possíveis causas da obstipação; avaliar a utilização de laxantes; identificar que tipo de intervenção é feita pelo farmacêutico nesta temática; avaliar qual o grau de conhecimento da sociedade relativamente à obstipação e ao uso de laxantes e elaborar o Protocolo de Intervenção Farmacêutica na obstipação. Trata-se de um estudo descritivo e transversal que se baseou na realização de um questionário de resposta fechada a utentes da Farmácia Damaia. Foram inquiridos 300 voluntários, de ambos os géneros, com idades compreendidas entre os 1-88 anos (45,15 ± 20,16 anos), após consentimento de participação. O questionário abordou diversas áreas, nomeadamente estilo de vida, rotinas e hábitos defecatórios e xvi utilização de laxantes. Os dados foram tratados no programa Microsoft Excel® 2007 e posteriormente analisados. Através do estudo foi possível percecionar que são várias as falhas existentes ao nível dos conhecimentos da população, nomeadamente em relação aos princípios básicos do funcionamento intestinal. Este estudo também demonstrou que existem lacunas nos conhecimentos acerca dos tipos de obstipação e na utilização de laxantes. Torna-se percetível que é fundamental o processo de instrução da população em relação a esta e outras temáticas relacionadas com a saúde. Assim, o farmacêutico deve tornar-se mais pró-ativo e intervir nesta área, para benefício de toda a sociedade.